Orthopedic Casts

holds a broken bone in place as it heals

help to prevent or decrease muscle contraction, and are effective at providing immobilization, especially after surgery

What is cast?

2 Different Kinds Casting Materials:

Plaster – white in color - consist of a cotton

bandage that has been impregnatedFiberglass – comes in a variety of

colors, patterns, and designs

What are cast are made of?

the skin under the plaster becomes dry and scaly because the discarded outer skin cells are not washed or brushed off

plaster of Paris casts can result in cutaneous complications including macerations, ulcerations, infections, rashes, itching, burns, and allergic contact dermatitis, which may also be due to the presence of formaldehyde within the plaster bandages

Limitations of Plaster Cast

their weight, which can be quite considerable, thus restricting movement, especially of a child

plaster of Paris casts break down if patients get them wet

1970s – development of fiberglass casts

More lighter and durable1990s – introduction of new casts

liningcompletely waterproof, allowing

patients to bathe, shower, and swim while wearing a cast

Fiberglass Casts

Type of Cast Location Uses

Short arm cast: Applied below the elbow to the hand.

Forearm or wrist fractures. Also used to hold the forearm or wrist muscles and tendons in place after surgery.

Long arm cast: Applied from the upper arm to the hand.

Upper arm, elbow, or forearm fractures. Also used to hold the arm or elbow muscles and tendons in place after surgery.

Arm cylinder cast: Applied from the upper arm to the wrist.

To hold the elbow muscles and tendons in place after a dislocation or surgery.

What are the different types of casts?

Type of Cast Location Uses

Shoulder spica cast: Applied around the trunk of the body to the shoulder, arm, and hand.

Shoulder dislocations or after surgery on the shoulder area.

Minerva cast: Applied around the neck and trunk of the body.

After surgery on the neck or upper back area.

Short leg cast: Applied to the area below the knee to the foot.

Lower leg fractures, severe ankle sprains/strains, or fractures. Also used to hold the leg or foot muscles and tendons in place after surgery to allow healing.

Leg cylinder cast: Applied from the upper thigh to the ankle.

Knee, or lower leg fractures, knee dislocations, or after surgery on the leg or knee area.

Type of Cast Location Uses

Unilateral hip spica cast:

Applied from the chest to the foot on one leg.

Thigh fractures. Also used to hold the hip or thigh muscles and tendons in place after surgery to allow healing.

One and one-half hip spica cast:

Applied from the chest to the foot on one leg to the knee of the other leg. A bar is placed between both legs to keep the hips and legs immobilized.

Thigh fracture. Also used to hold the hip or thigh muscles and tendons in place after surgery to allow healing.

Bilateral long leg hip spica cast:

Applied from the chest to the feet. A bar is placed between both legs to keep the hips and legs immobilized.

Pelvis, hip, or thigh fractures. Also used to hold the hip or thigh muscles and tendons in place after surgery to allow healing.

Type of Cast Location Uses

Short leg hip spica cast:

Applied from the chest to the thighs or knees.

To hold the hip muscles and tendons in place after surgery to allow healing.

Type of Cast Location Uses

Abduction boot cast: Applied from the upper thighs to the feet. A bar is placed between both legs to keep the hips and legs immobilized.

To hold the hip muscles and tendons in place after surgery to allow healing.

crutcheswalkerswagonswheelchairsreclining wheelchairs

Assistive devices for children with casts include:

Keep the cast clean and dry.Check for cracks or breaks in the

cast.Rough edges can be padded to

protect the skin from scratches.Do not scratch the skin under the

cast by inserting objects inside the cast.

Cast Care Instructions:

Can use a hairdryer placed on a cool setting to blow air under the cast and cool down the hot, itchy skin. Never blow warm or hot air into the cast.

Do not put powders or lotion inside the cast.

Cover the cast while your child is eating to prevent food spills and crumbs from entering the cast.

Prevent small toys or objects from being put inside the cast.

Elevate the cast above the level of the heart to decrease swelling.

Encourage your child to move his/her fingers or toes to promote circulation.

Do not use the abduction bar on the cast to lift or carry the child.

The stockinette with a hole for the thumb is slipped over fingers, hand, forearm and elbow. It should exceed the ends of the cast by 5cm at least. To set the bones a suspension with a weight of 2-3kg on the upper arm is used.

Procedure: Short Arm Cast

Then a cotton wool bandage is wrapped, which should exceed the ends by 5cm at least. Particularly the area of the wrist should be padded well. After that, paper bandages are applied to compress the padding.

A longuette with a hole for the

thumb is put on the inner side

of forearm and hand. If fibreglass

is used the longuette is dispensable.

Now one casting bandage follows.

It is important that the line of

knuckles is not squeezed.

After the suspension is removed

corrections of the cast could be made.

Finally the padding is fold down at the thumb and both ends of the cast. It is secured under the last layer of casting bandages.

If swellings could occur the cast should be split on one side and an elastic bandage be wrapped round.

The application is similar to a

short arm cast. But here, an

extra stockinette for the thumb

is needed. Further, the longuette is cut and the smaller stripe surrounds the thumb.

The hand should be fixed in

a position in which the tips of

thumb and forefinger can reach each other.

Procedure: Short Arm Cast w/ Thumb

Wounds will be covered by compresses. The padding, if necessary, is applied in accordance with the short arm cast. A plaster longuette covered by a stockinette is used as splint. It can be put on the inner (volar) or the outer side (dorsal) of the hand

Procedure: Forearm Splint

If one puts the plaster splint directly on the skin without padding, the set and dried material should be covered with another stockinette. Finally, elastic bandages are wrapped round the splint

The procedure is similar to the forearm splint. The splint can be put on the inner (volar) or the outer side (dorsal) of the hand. It depends on the position of the wound.

Padding is here essential. Furthermore, one puts gauze strips between the included fingers. To control circulation and sensibility, the fingertips should not be covered with bandages.

Procedure: Forearm splint with Thumb

One starts with the stockinette which reaches the shoulder. After setting the bones align cotton wool and paper bandages are applied. The first casting bandage follows.

If plaster is used a longuette is put on the outer side of the arm.

Procedure: Long Arm Cast

Further casting bandages follow. Finally, the padding is fold down at both ends of the cast and is secured under the last layer.

During the application the patient should lie face downwards and the lower leg is in a vertical position (see figures). The stockinette exceeds knee and toes. Cotton wool and paper bandages to compress the wool follow. Achilles tendon and places where bones are located immediately under the skin should be padded well.

If plaster is used one applies a first circular

layer. It is dispensable if no pressure is put

on the cast.

Procedure: Short leg cast

Then a L-like longuette is prepared,

that lies on the back of the lower leg and

on the sole of the foot. If a walking cast is

made a further longuette is put on the sole.

Another circular layer follows. Finally, the

padding is fold down at both ends of the cast and is secured under the last layer. A further bandage can fix a walking sole to the cast.

If fibreglass is used only one longuette is put onto the first layer of bandages on the sole. Two layers follow.

The stockinette is pulled over the whole leg. Cotton wool and paper bandages follow. Especially the part above the ankle, where compression could occur, also the knee and the cast border at the thigh should be padded well. Only in the case of plaster, two longuettes are put on the outer sides of the leg. After cast bandages were applied, padding and stockinette are folded down and secured with another bandage. The cast could slip if the parts above the ankle and around the knee are not prepared well.

Procedure: Cylinder Cast

The knee should rest in an angle of 155-170°. Pains occur after a period of time in a 180° position. In the case of plaster the padding and the first layer is followed by an U-like longuette. It lies on the sides of the leg and runs round the heel. In the case of fibreglass this longuette is unnecessary.

Procedure : Long Leg

In both cases after the second layer a longuette is put on the sole that exceeds the toes (toe plate). The third, and after folding down padding and stockinette, the fourth layer of casting bandages follow. In the case of plaster a fifth layer is needed usually.

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